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Recognizing the signs of Brachycephalic Airway Syndrome

Kathryn Rosalie Dench, DVM
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Recognizing the signs of Brachycephalic Airway Syndrome

Gaining a better understanding of Brachycephalic Airway Syndrome (BAS) in dogs is key to advising your clients on best management practices.

The selective breeding that has given brachycephalic breeds such as Chihuahuas, Pugs and French Bulldogs their distinctive flat faces has concurrently led to compression of the upper respiratory anatomy. The extent of these anatomical differences and the degree to which they cause airway obstruction is variable between breeds and individuals. In this article we look at how to identify Brachycephalic Airway Syndrome (BAS) and recommendations for management.

Brachycephalic Airway Syndrome

BAS is defined as airway obstruction caused by primary characteristics such as stenotic nares, soft palate elongation and hyperplasia and tracheal hypoplasia. The resultant air turbulence in the upper respiratory tract can lead to secondary abnormalities including everted laryngeal saccules and laryngeal or tracheal collapse.1,2

Patients often present with a combination of stridor, inspiratory dyspnea and exercise intolerance; in severe cases, heat stroke and episodes of cyanosis or syncope may occur, and the airway obstruction may be life-threatening.

Diagnosis of BAS is based on assessment of the respiratory anatomy in relation to published criteria to identify abnormalities; as such, the diagnosis is made by laryngoscopy and/or tracheoscopy. Surgical techniques have been developed to address several of the abnormalities associated with BAS with the aim of reducing the upper airway obstruction, including rhinoplasty, soft palate resection and removal of everted laryngeal saccules.3 There is evidence that early intervention leads to a better prognosis, as secondary laryngeal changes can be present in puppies as young as six months old.4 However, some abnormalities such as tracheal hypoplasia cannot be treated surgically, and correct management will continue to be important in BAS patients.

Management recommendations

There are a number of management recommendations we can make to our clients with brachycephalic breeds to reduce the issues associated with their respiratory anatomy.

Exercise

It is important to consider advice for safe exercise management for dogs suffering from BAS: over-exertion and overheating can precipitate breathing problems, but conversely obesity exacerbates airway obstruction. These dogs should not undertake strenuous exercise outdoors in hot or humid weather; owners should be encouraged to provide their dogs with alternative opportunities for moderate exercise in a cool air-conditioned environment.4,5

Use of a harness

A standard collar and lead can put intense pressure on the trachea and exacerbate symptoms of BAS, sometimes triggering tracheal collapse. Use of a low-front harness is recommended for these breeds, even if they are not showing symptoms of BAS.6

Hyperthermia awareness

Owners of brachycephalic breeds need to understand that their dog may not be able to cool down by panting as effectively as other breeds, and take preventative measures to protect their dog from overheating. Advice includes avoiding being outdoors in hot weather, checking the pavement is not too hot for walking barefoot, and maintaining a cool temperature within the home. Owners should also be made aware of the signs of heat stroke and the importance of acting quickly if they notice these symptoms in their dog.

Conclusion

The degree of airway obstruction experienced by brachycephalic dogs varies widely, and not all meet the criteria for diagnosis of BAS. As clinicians, it is important that we educate our clients on the early signs of BAS and make timely surgical and management recommendations.

References

1Brachycephalic Airway Syndrome from PetMD: https://www.petmd.com/dog/conditions/respiratory/c_multi_brachycephalic_airway_syndrome

2Lodato, D.L., & Hedlund, C.S. (2012). Brachycephalic airway syndrome: pathophysiology and diagnosis. Compend Contin Educ Vet, 34 7, E3.

3Lodato, D.L., & Hedlund, C.S. (2012). Brachycephalic airway syndrome: management. Compend Contin Educ Vet, 34 8, E4.

4Pink, J. J., et al. “Laryngeal collapse in seven brachycephalic puppies.” J. Small Animal Practice 47.3 (2006): 131-135.

4Brachycephalic-friendly exercise ideas from American Kennel Club: https://www.akc.org/expert-advice/dog-breeds/sports-snouts-and-extreme-weather-workout-safety-for-flat-faced-dogs/

5Harnesses for brachycephalic breeds from WileyPup: https://www.wileypup.com/best-harness-for-french-bulldog/

Using therapeutic grooming for treating chronic back pain in horses

Leslie Stevenson, EVT
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Using therapeutic grooming for treating chronic back pain in horses

Do you have equine patients with behavioral issues? This could be a sign of chronic back pain, which can lead to a variety of other medical issues.

As an Equine Laser Therapist, I find that many horses have issues with back pain and their owners very often have no idea that their horses are dealing with chronic pain. If pain anywhere in the body is overlooked, the horse will be at risk for many other types of injuries due to compensation. Although it only rarely causes outright lameness, back  pain is a common cause of behavioral issues, such as:

  • Resistance to the bridle
  • Reluctance to engage hind legs
  • Tension/nerves
  • Spooking or bolting
  • Rearing or bucking
  • Resistance to saddling/girthiness
  • Head tossing
  • Heaviness in the hand
  • Problems picking up or holding a particular canter lead
  • Reluctance to go forward
  • Moving with short, choppy strides
  • Leaning or bracing against one or both reins
  • General decline in performance or attitude

Soreness can be anywhere from right underneath the saddle (which is often a saddle fitting issue), to the lumbar region of the back (which is often due to conformation and muscle weakness in that area, or from carrying tension under saddle), to the lumbosacral junction and the sacroiliac joint (which can be from injury, weakness, or poor riding.)

Treating back pain in horses

Pain in any of these areas can easily become a vicious circle… with the structures becoming weaker and more vulnerable as the horse protects them. As equine veterinarian Jenny Johnson says, “all the performance horses I work with, despite being in different disciplines, push from behind. They must be able to engage their hind end. If a horse has back pain, he is unable to do this very effectively; the pain makes him reluctant to fully use his body.”

Regular use of therapies such as laser therapy, acupuncture, and massage can be highly effective in keeping your horse’s back, as well as other areas, comfortable. However, these therapeutic modalities are not always easily accessible to everyone. Some may live in remote areas where they are simply not readily offered. Others may find that financial limitations make it difficult to afford regular treatments for their horses.

For those of you who may fall into either of those categories, therapeutic grooming is a great alternative that has been proven to be exceptionally effective.

The importance of a therapeutic grooming routine

Why is massage so beneficial? Massage increases circulation, blood flow, and nutrients. As with humane athletes, when muscles are warmed prior to work, the horse will have improved mobility and reduced risk of injury. After work, massage will aid muscle recovery. For soft tissue injury, massage can reduce swelling, relieve soreness, and speed healing.

When using a therapeutic grooming tool over target areas, one can effectively stimulate the horses’ muscles and increase circulation to a far greater degree than simply using the hand as seen in the photos below (increased blood flow shown in white).

Showing theraputic benefits of massage for back pain

other benefitsWhen gliding the tool over the horse’s body one can clearly feel the muscles relaxing and identify sore spots. The fascia can be warmed and stretched before doing the deeper work of massage on the large muscles. Caring for the legs using an appropriate therapeutic grooming tool can help increase blood flow and decrease swelling. This type of leg care is especially important for stall-bound, athletic, senior and injury recovery horses.

A horse can reap the benefits of massage through a simple daily grooming routine. It’s a great alternative to therapeutic modalities that are not always easily accessible, ensuring your patients are comfortable and happy.

 

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Feline enteric coronavirus and feline infectious peritonitis virus – a Dr. Jekyll and Mr. Hyde story

Kelly Diehl, DVM, MS, Dipl. ACVIM
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Feline enteric coronavirus and feline infectious peritonitis virus – a Dr. Jekyll and Mr. Hyde story

In light of the COVID-19 pandemic, learn how research on feline infectious peritonitis virus could help fight coronavirus infections in people.

As the COVID-19 pandemic rages on, researchers and governments, as well as news organizations, are paying much more attention to coronaviruses and the diseases they cause. This increased attention COVID-19 has brought places a spotlight on feline infectious peritonitis (FIP), a disease veterinarians have been battling for decades. The benign feline coronavirus that turns into the monstrous feline infectious peritonitis virus is a true Jekyll/Hyde story. Despite decades of research, the prognosis is dismal for cats afflicted by FIP. Although the prognosis for affected cats remains grave, new research might change the course of this disease – and help people affected by coronavirus infections, as well.

Feline coronaviruses have a worldwide distribution and affect both domestic and wild cats. Most cats are exposed to feline enteric coronavirus (FECV) and infected at some time in their life. FECV is highly contagious and transmitted easily through saliva or feces. Very few cats show any symptoms and most recover uneventfully without requiring veterinary care.

After years of speculation, it is now clear that FECV can randomly mutate to feline infectious peritonitis virus. While it’s estimated that only 5% to 10% of infected cats develop feline infectious peritonitis, it is 100% fatal. Feline infectious peritonitis is most common in cats under three years of age, with more than 50% of cases in cats under one year of age. A second spike in cases has been noted in  cats over 10 years of age.

At highest risk are cats that live in close proximity to each other, such as cats that live in shelters, where FIP is five to 10 times more prevalent. Certain breeds of cats are predisposed. Although the exact mechanisms underlying genetic susceptibility to the disease are unknown, they are suspected given breed incidence and evidence that siblings of cats that succumb to FIP may be at increased risk for the same disease, even if living apart.

FIP is difficult to diagnose, and effective treatments currently are not available. However, two newly funded studies underway at Colorado State University, hope to change that paradigm.

Under the leadership of Dr. Gregg Dean, Professor and Head of the Department of Microbiology, Immunology and Pathology in CSU’s College of Veterinary Medicine and Biomedical Sciences, a research team is constructing an oral vaccine for feline enteric coronavirus. If successful, the vaccine will control pervasive FECV infection in shelters and other multi-cat environments, while also protecting individual cats against FIP.

“For years, we have tried, unsuccessfully, to vaccinate against feline infectious peritonitis, but we may have been targeting the wrong point in time,” said Dr. Dean. “Our strategy now is to eliminate FECV, the mild-mannered Dr. Jekyll form, if you will, before it can become the deadly Mr. Hyde.”

The team’s vaccine design will exploit the bacteria Lactobacillus acidophilus, familiar to most as a probiotic and inhabitant of the gastrointestinal tract. The vaccine uses specific FECV antigens to generate protective antibodies against infection by FECV.

The vaccine is designed to be given orally, rather than injected, for several reasons. Oral vaccines are preferred by cats and their owners. Oral vaccination avoids the risk of injection site sarcoma. And, since exposure occurs at the mucosal surface of the intestinal tract, an oral vaccine would hopefully stimulate a more vigorous response at the point of infection, as opposed to an injectable vaccine that might be ineffective at stimulating an adequate mucosal immune response.

Dr. Dean’s team also is tackling another elusive goal – developing an accurate diagnostic test for feline infectious peritonitis. The test would use a blood sample to look for biomarkers consistent with disease. His team has identified 18 proteins, among thousands, that appear to be common in cats with the disease. The researchers aim is to evaluate the proteins as markers for FIP and determine which ones can be detected easily and developed into a diagnostic test.

A final exciting development is that Dr. Dean’s work on a feline coronavirus vaccine has the potential to inform work on a vaccine for the current coronavirus pandemic. The research team has now focused their attention – and their expertise – on SARS-CoV-2.

“Our work on a feline coronavirus vaccine has allowed us to quickly engage in work to assess the same approach against SARS-CoV-2,” said Dr. Dean. “I strongly believe the lessons learned over years of work by many investigators to develop a vaccine for cats can be directly applied to the current pandemic.”

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Common health issues for flat-faced dogs

Pete Wedderburn, BVM&S CertVR MRCVS
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Common health issues for flat-faced dogs

Pugs, shih-tzus, bulldogs, and other flat-faced dogs are more popular than ever, so there’s no time like the present to become more familiar with their unique health issues. 

A flat-faced dog’s compacted facial anatomy causes increased effort with every breath. Despite the added effort, these dogs often suffer from reduced airflow to the lungs, which can lead to Brachycephalic obstructive airway syndrome (BOAS). Symptoms include:

  • Snorting, grunting sounds
  • Wheezing on inhale
  • Gagging and coughing
  • Snoring
  • Collapsing during or after exercise

Dogs with BOAS may require surgery to shorten the soft palate, which is typically elongated in short-faced dogs. In addition, many of these dogs require surgical resection to open the larynx and nostrils. Even without BOAS, brachycephalic dogs require special anesthesia considerations . This is why most airlines have restrictions against snub-nosed breeds, as flying can bring added health risks.

Heart disease

Facial conformation is often a primary factor when flat-faced dogs present with heart disease. Because the lungs receive less than the optimal amount of air, blood oxygen levels are often chronically low, placing added strain on the heart.

Heatstroke

Brachycephalic dogs are prone to overheating and heatstroke, as their facial conformation prohibits effective cooling. Clients with short-faced dogs like French Bulldogs should be advised to keep their pets cool during hot weather, opting for exercise during early mornings and after the sun goes down rather than during the hottest part of the day. Clients can also help their pets by walking them on a harness instead of attaching the leash to the dog’s collar.

Dental problems

All dogs require regular dental cleaning, but flat-faced breeds tend to have more dental problems than their longer-nosed cousins. Check for overcrowded teeth and urge clients to practice good doggie dental hygiene at home between regular visits.

Ocular injuries and eye disease 

Most flat-faced dogs also have protruding eyes. Cherry eye, dry eye, and eye ulcers are common issues for these dogs, and so are ocular injuries, often sustained during everyday activities and play sessions.

Facial skin infections and ear infections

Where there are skin folds, there’s an increased risk of bacterial buildup and infection – and most of these dogs have pronounced facial folds. In addition, their ear canals are often narrower than average, which can lead to a higher frequency of ear infections. Teach clients to conduct routine facial fold and ear cleanings; if they’re unable to do so, advise them to have their dogs professionally groomed on a regular basis.

Obesity

Obesity is a problem for any dog, but it magnifies many of the common health issues flat-faced dogs tend to suffer from.

Being overweight makes BOAS symptoms worse since fat deposits in the chest and neck restrict breathing further. Obesity intensifies the likelihood of heat stroke in short-nosed dogs, and it greatly increases their risk of suffering heart disease and diabetes. Urge clients to keep their brachy dogs at a healthy weight, focusing on regular exercise and an appropriate diet.

While surgery can help flat-faced dogs with severe BOAS, prevention is key to better health overall.

The TCVM approach to treating geriatric patients

Michelle Tilghman, DVM, CVA, CCRP
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The TCVM approach to treating geriatric patients

When treating geriatric patients, TCVM can help diagnose and alleviate pain, while also restoring the animal’s quality of life.

As a veterinarian, I find that treating geriatric patients is among my most challenging and rewarding missions. Restoring joy and mobility to a grateful animal, along with the recognition that he is now pain-free, is the underlying motivation behind my life’s work. Moreover, the animals’ owners are so thankful to have additional quality time with their babies that they are likely to remain our clients forever. I know these patients come to my clinic in order to finish their lives in a loving, supportive environment. Just as there are midwives who aid with the transition into life, I feel like a midwife to death, the one who gently guides animals toward their final portals in life. For these reasons, I have embarked on a journey to love and care for geriatric souls, using a TCVM approach.

The temperature questions

As with youthful patients, we begin our work with the basic Yin and Yang questions and establish where the geriatric patient is. Ask the following temperature questions:

  • Is the animal heat- or cold-seeking?
  • In what weather conditions does he feel best?
  • Does he pant at night or is he under the covers?
  • Check the tongue for color and hydration. Red or pale? Dry or wet?
  • Has there been any change in behavior?
  • Has he exhibited aggression toward housemates and/or humans?
  • Does he seem to be in pain?

First, treat the pain

Always treat pain first. Pain is a stasis – a stagnation of the flow of Qi, blood flow or joint motion. Many geriatric patients are in pain due to a decrease in fluids (Yin) and not enough motion (Yang). These areas of stasis become stagnant, “stuck”, and they hurt. Pain can be caused by an area of Damp Cold stasis, or an area of Hot Dry stasis where too much Heat has depleted the Blood. Initiating movement in the area of stasis is a simple way to start the process of healing pain.

Bi and Wei SyndromesConsider the tongue and pulse when diagnosing stasis. The pulse often has an irregular, choppy, thin quality to it when an animal is in pain. The tongue may show redness and Heat. Establish the location, nature and extent of the pain through close observation of movement and behavior.

In geriatrics, behavior changes can be signs of pain or a loss of sensory organ function. Aggression toward a playful younger animal in the house can be the older one saying, “That hurts! Leave me alone!” Changes in urination or defecation habits may also be caused by pain. For example, I recently worked with an older poodle that had been rescued from desperate circumstances as a young animal. She had recently begun urinating in the house and on the deck. Her owners had enrolled her in an obedience class in an attempt to stifle this behavior; however, radiographic images revealed an old poorly-healed pelvic fracture her owners had been unaware of. The cold weather, coupled with the slippery stairs leading to the yard, made it difficult for the dog to urinate anywhere else. Letting her out through a different door – one without stairs – remedied the behavior in short order.

Treatment modalities for pain

The modern veterinarian has a variety of treatment approaches at hand to combat pain in geriatric patients. Once the diagnosis has been made, practitioners may select from multiple treatment modalities, including conventional medicine, acupuncture, physical rehabilitation, chiropractic treatment, prolotherapy, nutrition, homeopathic  and herbals to develop a tailor-made plan to meet the individual patient’s needs.

Conventional approaches include the use of NSAIDS, opioids and Adequan. A multimodal approach will combine the different modes and sites of action of the various agents in order to increase pain relief while reducing dosages and possible side effects. Owner education is an important aspect of the multimodal approach. Teaching owners how to recognize pain and educating them on topics such as weight control, exercise, and environmental management (e.g., flooring, bedding, etc.) is a critical part of effective treatment.

Acupuncture

The TCVM approach to geriatrics should always include the use of acupuncture. Electroacupuncture is one of the most effective methods of moving areas of stasis and quickly increasing the pain threshold. More-than-adequate research documents the efficacy of acupuncture as a method of pain relief. Acupuncture analgesia is seen more intensely along the meridian of the point being stimulated. Consideration should be given to the points used, and if they should be local or along muscle channels.

There is also evidence that acupuncture may assist in recovery from spinal cord injuries, which are common in geriatric patients. Dogs with spinal cord injuries who received a combination of conventional veterinary treatment and electroacupuncture had better recovery in urinary control, conscious proprioception and ambulation when compared with those who received conventional treatment alone.1

The main meridians that are effective from a TCVM perspective are the Yang meridians, which are responsible for gross motor muscle movements. The ability to get off the floor, squat to potty, and walk up stairs involve the following meridians:

  • Bladder meridian – controls the major superficial back muscles
  • Stomach meridian – the psoas and quadriceps
  • Gall Bladder meridian – the lateral muscles of the body, including the gluteal muscles

The most effective points are the major points in the muscles from the proximal to the distal meridian:

  • BL11
  • BL23
  • BL28
  • BL40
  • BL54
  • BL60
  • GB29
  • GB30
  • GB34
  • ST36
  • KD3

Second, establish a TCVM diagnosis

Constitutional elements

The constitutional element of the animal should be taken into consideration when making a TCVM diagnosis. A patient’s element can be a clue to the TCVM diagnosis.

  • Water — Kidney: Is the animal fearful? Does he have a history of inappropriate urination or urinary incontinence?
  • Wood – Liver and related behaviors: Does he have a short fuse? Terriers in particular have a temper and are often Wood animals.
  • Fire – Heart: Older Fire animals were previously very active and energetic, but have lost that essential nature.
  • Metal — Lung: Is the animal aloof? Has he developed respiratory symptoms, particularly as he has aged?
  • Earth – Spleen: Has the animal’s digestion been affected as he has aged? Are his stools dry and hard or too wet?

The TCVM diagnosis is always valuable. There seem to be two schools of thought on the core cause of deficiency in traditional Chinese medicine — one that focuses on the Kidney and the other the Spleen. The Spleen school sees the Spleen as the center of deficiency because it is responsible for the transportation and transformation of Gu Qi (food); this is an important consideration when evaluating the diet of a geriatric animal. In aging humans, the digestion of protein is reduced due to a decrease in hydrochloric acid. I find this to be true in aging animals as well. Simple strategies such as changing the animal’s diet to something more easily digested (from dry to wet), and feeding smaller more frequent meals can be beneficial. Also, cooking and serving the food warm can help feed the Spleen, thereby increasing Postnatal Kidney Qi and replenishing Kidney Jing.

Patterns of deficiency

Most of our geriatric patients will have deficiency patterns. First, the Qi is deficient, then the Blood becomes deficient and stagnant. The body fluids, not being nourished by the Blood, will dry up and condense to phlegm. The Jing, not having nourishment, will then become deficient. Most geriatric patients have some degree of deficiency, and zeroing in on the correct one can restore their vitality. Below are the different patterns of Kidney and Spleen deficiencies. Those that are starred are the most common:

  • Kidney Yang Deficiency*
  • Kidney Yin Deficiency*
  • Kidney Qi Not Holding Firm*
  • Kidney Failing to Receive Qi
  • Kidney Jing Deficiency*
  • Kidney Yang Deficiency Water Overflowing
  • Kidney Yin Deficiency Empty Heat Blazing*
  • Kidney and Liver Yin Deficiency*
  • Kidney and Heart Yin Deficiency*
  • Kidney and Lung Yin Deficiency*
  • Kidney and Spleen Yang Deficiency*

When determining the deficiency pattern of patients, remember that the Spleen is responsible for the Qi in the body, and for the transportation and transformation of food (without food, there would be no Qi). The Liver is like a tree, moving the Qi upward and outward through the body. When the Spleen is damaged, the Qi will be decreased due to impaired digestion. When Qi decreases, the Blood is affected and becomes deficient. The Spleen is very sensitive to Cold and Damp; it prefers Dry and Warm. Spleen deficiency patterns are therefore as follows: Qi Deficiency, Yang Deficiency, Damp Cold, and Damp Heat.

In veterinary medicine, older patients are some of the most challenging to treat. Begin by checking the tongue, feeling the pulse, and differentiating between Yin and Yang patients. When proceeding with treatment, use the points that work for you and try some of the empirical Wei points (see sidebar above). Proceed with a TCVM diagnosis, as this is always helpful when treating patients with multiple modalities. Remember, your first goal as a practitioner is to diagnose and alleviate pain. Your second goal is to restore the geriatric animal’s quality of life, using every modality available to you.

* This article has been peer reviewed

References

1Xie H,  Wedemeyer L.” The validity of acupuncture in veterinary medicine”. AJTCVM 2012;7:35-43.

Beijing College of TCM. Essentials of Chinese Acupuncture. Beijing, China: Foreign Language Press, 1980.

Dung HC.  Anatomical Acupuncture. San Antonio, TX: Antarctic Press, 1997.

Fratkin JP.  Chinese Herbal Patent Medicines. Boulder, CO: Shya Publications, 2001.

Han, Hyun-Jung. “Clinical effect of additional electroacupuncture on thoracolumbar intervertebral disc herniation in 80 paraplegic dogs”. AJCM 2010;38:1015-1025.

Hayashi AM, Matera JM, Fonseca Pinto, AC. “Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs”. JAVMA 2007;231:913-8.

Johnson JA. Chinese Medical QiGong Therapy. Pacific Grove, CA: The International Institute of Medical Qigong, 2005.

Kendall D.  Dao of Chinese Medicine. New York, NY: Oxford University Press Inc, 2002.

Maciocia G. The Foundations of Chinese Medicine. London, England: Churchill Livingstone, 1989.

Maciocia G. The Foundations of Chinese Medicine. 2nd ed.  Churchill Livingston, 2011.

Schaeffer R.  IVAS Teaching Manual, Sess. 4, pp. 612-614, 2010.

Schoen A. Veterinary Acupuncture. St. Louis, MO: Mosby, Inc., 2001.

Xie H, Preast V. Traditional Chinese Veterinary Medicine. Reddick, FL: Jing Tang, 2002.

 

 

Smart.Vet: using telehealth to bridge the gap in veterinary patient care

IVC Journal
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Smart.Vet: using telehealth to bridge the gap in veterinary patient care

Veterinarians rush to register for clinic-branded telehealth platform that’s up and running in as little as 24 hours. Take that, COVID-19!

In the wake of COVID-19, veterinarians are turning to telehealth technology to help bridge the gap in patient care. Smart.Vet, a telehealth platform designed by practicing veterinarian Dr. Sharon Quinn and her partners, has set up over 200 veterinary clinics all over the world in just the last few weeks alone, as veterinarians endeavour to find their way, both logistically and financially, through the pandemic. Since COVID-19 began, Smart.vet has had over 6500 consultations performed through their system.

“Veterinary care is considered an essential service, but with social distancing and quarantine measures in place, including guidelines on postponing in-person elective and wellness procedures, we are seeing mainly urgent cases in clinic” explains Dr. Quinn. “With our platform, you can have a secure, web-based telehealth option in place — serving clients and patients, and earning revenue — in as little as 24 hours. And right now, that’s more important than ever.”

The Smart.Vet team designed the platform with accessibility in mind, enhancing it over the last 2.5 years. Clients can reach out securely through messaging, phone, or the platform’s own proprietary peer-to-peer video hosting option, using a computer, tablet, or smartphone. This private one-on-one interaction is kept on record so clients can refer to it later.

The company says thousands of pet owners use the service for a variety of reasons. “The cases range from triage of acute problems, to more chronic medical concerns, to post-operative re-evaluations, behavioral and nutritional consults and much more,” says Dr. Quinn.

While the platform has a lot of bells and whistles, veterinary practitioners agree that one of the most compelling advantages is Smart.Vet’s ability to be custom-branded to each clinic rather than a third party site. Clients like Bayridge Animal Hospital in Kingston, Ontario have taken full advantage of the editable landing page that comes included with the platform, showcasing photos of their veterinary staff along with a customized statement to their clients.

“Our patients and families are very important to us,” says Bayridge veterinarian Dr. Jeff Kaufmann. “We are glad to be able to use Smart.Vet’s innovative technology to keep us closely connected to our patients, especially through challenging times.”

The entire experience is simply an extension of the clinic’s services – even client payments can be processed through Smart.Vet. So pet owners never have to leave the branding they’re familiar with.

Smart.Vet offers veterinary clinics a number of advantages, including continuity and accessibility of care, more flexible hours for better work/life balance, improved client compliance and communication, and a way to seamlessly monetize telehealth services.

“Smart.Vet allows us to interact professionally, be attentive to our clients, share information like articles, videos, and estimates, and incorporate billing all in one platform,” explains Dr. Quinn. “Pet parents see huge value in having this dedicated one-on-one communication with their veterinarian, as well as access to their pet’s medical record and consultation history. And it’s so easy to share with their family members, which helps with their decision making.”

Dr. Alan Poon, associate veterinarian at Ontario-based Allandale Veterinary Hospital, agrees. “The simplicity of Smart.Vet makes it easy to use from a computer or handheld device, and I appreciate the functionality of having a centralized platform to reply to messages, perform video consultations and invoice clients with the click of a button,” says Dr. Poon. “Feedback from our pet parents has all been positive. Smart.Vet telehealth has helped advance the high standard of care we provide at our hospital.”

The Smart.Vet telehealth platform is easy to implement because there are no upfront costs. Once it’s up and running, there is a low monthly cost, starting at $99 (which includes two consulting accounts). Additional consulting accounts (DVMs or RVTs/technicians) can be added for the low cost of $40 per month each. Consultations are unlimited and Smart.Vet does not charge transaction fees. With such reasonable prices, many clinics are realizing a Return on Investment (ROI) of 600% or better.

Smart.Vet’s technology has been reviewed by the College of Veterinarians of Ontario (Canada) and it is the only telehealth program in Canada currently operating under an accredited facility. The company serves clients in several countries, including the U.S., Canada, Australia and the U.K. The French language version of the platform is currently being used in dozens of practices as well. Other translations are sure to follow.

A complimentary demonstration of the Smart.vet platform is available by contacting Mike Parent at mike@smart.vet.

 

FOR IMMEDIATE RELEASE: May 7, 2020

CONTACT:  Michael Parent, Phone # (336) 664-8400, mike@smart.vet

Understanding canine noise phobia

Debra F. Horwitz DVM, DACVB
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Understanding canine noise phobia

Many clients report fear-based behavioral problems in their dogs, including noise phobia. Understanding underlying reasons can help you determine treatment.

Approximately 90 percent of dog owners can describe at least one behavioral problem they would like to improve in their pet.1 Behavior problems can be a result of a dog responding to different triggers while home alone, and often there’s more than one trigger for any given patient. For instance, dogs with separation-related issues have been found to have noise phobia as well.6   Regardless of the trigger, 15 percent of veterinary patients are euthanized due to behaviour problems.1 Understanding the underlying reasons for canine noise phobia can help you assist your clients with structuring an appropriate treatment plan.

PRN Behavior Graph
Behavioral conditions are the #1 reason for euthanasia and relinquishment

Identifying triggers for anxiety

It is key for vets to complete a thorough medical history and physical examination as physical health influences behavioral health. Inquire about troubling behavior issues including territorial responses such as barking, growling, snarling or biting, and/or excessive restlessness.  Ask your client if there have been any recent significant life changes as well as the dog’s early history and environmental exposure. For best results, it is helpful to utilize a standard history form to give to clients prior to their vet appointment. Some common questions to include in the history form are the type of behavior the dog displays and the duration of the unwanted behavior, i.e. daily, for how many months, or for how many years.

Narrowing in on noise phobia triggers

To rule out other possible reasons for behavior problems, vets need to ask several questions that can include the following:

  • Does the dog show excessive reactions to unexpected noises and thunderstorms such as urination or defecation indoor, or the destruction or rearranging of household objects? If so, was it a day where storms were predicted and occurred or were there construction noises or other loud events near the home?
  • Does the dog bark during storms or noise-related anxiety episodes?
  • Has a fearful experience occurred when you were gone like a security system alarm sounding for extended periods, attempted break-ins, or fire alarms?

All of these questions with help isolate the triggers behind your patients’ behavioral problems.

Co-morbid diagnoses

Separation anxiety and noise/storm phobia are a very common co-morbid diagnosis. Forty-three percent of dogs in Storengen’s study of 215 dogs with separation anxiety also suffered from fear of noises.7 Flannigan and Dodman indicated in a study that fear of noises or noise phobia was present in conjunction with a separation anxiety diagnosis in almost half of studied dogs.8

Some research has found that behavioral responses to one loud noise are likely to generalise to others.4 However, responses to fireworks, gunshots and thunder did not commonly co-occur with separation-related behavior. In contrast, less salient noises such as traffic or the TV co-occur with separation anxiety, indicating that fear response to louder noises may relate to specific exposure and experiences.

Assisting with treatment

Research has shown that although owners are aware of their pet’s behavioral response when exposed to a loud noise, owners do not necessarily recognise this as being indicative of fear or anxiety.4 Furthermore, less than a third of owners seek professional guidance and treatment for their dog’s fear, showing that there is a need for veterinarians to increase treatment awareness among the general dog owning public. 4

Whenever owners mention noise or storm reactions in their dogs, vets should ask them to videotape the dog when it is home alone to ensure a full assessment. Once the diagnosis is verified and established, provide the owner with details of what the treatment plan would look like. Typical treatment plans include owner education, independence training, changing departure patterns, training departure exercises, and pheromones (if needed). Medication such as selective serotonin reuptake inhibitors (SSRI), have been shown to accelerate a dog’s response to behavior training, thereby reducing detrimental behaviors.

Many clients struggle with dealing with canine separation anxiety and noise phobia. Doing a thorough physical and behavioral assessment of patients will help vets determine the best form of treatment. Remember that early intervention is the best treatment option. This content came from a free, one-hour continuing education course on UniversityPRN.com entitled “Separation Anxiety: What’s New and What’s Different?” To participate in the entire CE course and learn more about separation anxiety, visit UniversityPRN.com.

References

  1. Landsberg G, Hunthausen W, Ackerman, L. Handbook of behavior problems of the dog and cat. 2003: 3.
  2. Stephen, J, Ledger, R. Relinquishing dog owners’ ability to predict behavioural problems in shelter dogs post adoption. Applied Animal Behaviour Science, 2006.
  3. Elanco Animal Health, unpublished data, 2006.
  4. Blackwell EJ, Bradshaw JWS, Casey RA. Fear responses to noises in domestic dogs: prevalence, risk factors and co-occurrence with other fear related behavior. Appl Anim Behav Sci. 2013; 145: 15-25.
  5. Overall K. The manual of Clinical Behavioral Medicine. 2013; 2.
  6. Sherman BL, Mills DS. Canine anxieties and phobias: an update on separation anxiety and noise aversions. Vet Clin North Am Small Anim Pract. 2008;38(5):1081–1106, vii.
  7. Storengen, Linn Mari, et al. “A descriptive study of 215 dogs diagnosed with separation anxiety.” Applied Animal Behaviour Science 159 (2014): 82-89
  8. Flannigan, G, Dodman, N. Risk factors and behaviors associated with separation anxiety in dogs. Journal of the American Veterinary Medical Association. 2001; 219. 460-6. 10.2460/javma.2001.219.460.
PRN Pharmacal Bottom

Phytomaxx

Rebecca Bloom
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Profitable Practice
Phytomaxx t

INCOME POTENTIAL:
Veterinarians who started using PhytoMAXX™ for pain management and separation anxiety are now using it for more complex issues. Clients want to buy hemp extract from the veterinarian, and not an unknown company, so the income potential increases further.
TRAINING REQUIREMENTS:
When using CBD, understanding the potential available to you is of the utmost importance to you and your staff. It’s also important to understand the laws surrounding cannabis use in your area. Doctors and techs should be educated on absorption rates and proper dosing of CBD. When you purchase PhytoMAXX™, an educational brochure for future and existing clients is supplied.
TIME TO IMPLEMENT:
PhytoMAXX™ can be implemented in your clinic immediately after purchase. Clients can begin using the product at home as soon as proper instructions have been provided to them. As experts in hemp extract, Animal Nutritional Products is able to offer any information required by you or your client.
SOME POTENTIAL USES:
Veterinarians and pet parents have successfully used PhytoMAXX™ for a wide range of health concerns, including pain, separation anxiety, skin issues, sterile cystitis, lack of appetite and IBD. Compared to tramadol, galliprant and fluoxetine, this product has been reported by pet parents to have a longer half-life (three to four hours more). While this result has not been clinically studied, it has been tested in clinics and through observation.

 

PhytoMAXX™ Plus is a full spectrum hemp extract available in a liquid or chewable formula that addresses the CB1, CB2 and TRPV1 receptors. These receptors are prevalent in the body and brain of the endocannabinoid system in all animals. The formulation is designed to repair this system, which controls the CNS, immune and GI systems. This hemp extract can eliminate or reduce the need for NSAIDs and fluoxetine consumption, and can be used as part of a multimodal regime for many everyday health issues in animals.

The attention given to CBD by the internet and media is overwhelming — there is a lot of “canna-confusion” out there,and clients are struggling to find safe, effective and fairly-priced products. Veterinarians are capitalizing on the CBD boom; the key is to purchase from a reputable company that knows the laws and regulations. PhytoMAXX™ is a veterinary exclusive product, so your clients won’t find it on the internet.

Clients are much more educated about alternative medicine these days, but they still need guidance when it comes to CBD. They are seeking alternative ways to alleviate issues other medications sometimes can’t help with, and offering a safe and effective hemp extract like PhytoMAXX™ offers them peace of mind with third party lab testing.

Dogs, COVID-19, and veterinary medicine

Lori Kogan, Ph.D.
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Dogs, COVID-19, and veterinary medicine

Has COVID-19 changed the relationship clients have with their dogs? A new study explores how the pandemic has impacted human, veterinary and pet relations.

Dogs play an important role in our lives – as well as those of our clients – as valued companions that contribute to both emotional and physical well-being. Numerous studies have found that those with a dog are healthier and happier. People sharing their homes with dogs are sick less frequently, make fewer visits to the doctor, have lower blood pressure and risk of heart disease, and are less depressed and stressed than those without a dog. Dogs also help people relax and reduce feelings of loneliness and isolation by buffering the negative effects accompanying a lack of other social connections. All these benefits occur during normal times, yet, during the COVID-19 pandemic, things are far from normal. The pandemic has brought countless changes to how we live our lives, creating an uncomfortable level of uncertainty, altering our daily routines, adding financial stressors, and increasing social isolation.

How have these changes impacted the relationship clients have with their dogs? What COVID-related concerns do people have regarding the care of their canine companions? Researchers from four different US universities set out to answer these questions through an online anonymous survey for those with dogs (there was a separate survey for those with cats).

Lifestyle changes

One of the first things we want to explore is how COVID-19 and the related schedule/lifestyle changes have impacted the amount of time people spend with their dogs. The results suggest there are many happy dogs – 72% of people report spending more time overall with their dog, with most participants reporting that this increased time strengthened the bond they feel with their dog. Given the fact that 29% of respondents reported feeling they have minimal social support now (compared to only 8% who felt that way before COVID-19), this bond is more important than ever. In addition, dogs appear to help people cope with many of the negative emotions that can accompany the changes created by the pandemic. Over 50% of people report feeling that their dogs help reduce their feelings of anxiety, depression, isolation and loneliness.

Access to veterinary care

The results suggest that dogs are playing a critical role for many people during these stressful times. It is not surprising therefore, that many owners are concerned about being able to provide and care for their dogs, including the ability to afford and access veterinary care as well as dog food/supplies. For example, when asked about their concern level related to their ability to afford emergency veterinary care, 42% of respondents expressed concern surrounding meeting current needs, and 45% expressed concern for meeting future needs. Perhaps even more alarming is that 61% of respondents reported concern that their veterinarian would not be there in the case of an emergency, and 53% indicated similar concern when asked about availability for non-emergencies.
While it would appear that most people are appropriately unconcerned about giving their dogs COVID-19 or contracting it from them, 60% did report concern about their ability to care for their dog if they themselves become ill. Yet, only 60% of respondents reported that they have identified someone to care for their dog if they become ill.

  No concern Minimal concern Some concern Great concern NA/not an issue
Ability to afford emergency veterinary care now 1183 (29.6) 931 (23.3) 1153 (28.9) 521 (13.0) 208 (5.2)
Ability to afford emergency veterinary care in the future 1051 (26.3) 975 (24.4) 1231 (30.8) 569 (14.2) 170 (4.3)
Ability to afford non-emergency veterinary care now 1629 (40.8) 1117 (28.0) 807 (20.2) 245 (6.1) 198 (5.0)
Ability to afford non-emergency veterinary care in the future 1516 (37.9) 1094 (27.4) 939 (23.5) 279 (7.0) 168 (4.2)
Concern that my vet will not be open/available if I need them for emergencies 598 (15.0) 860 (21.5) 1544 (38.9) 898 (22.5) 96 (2.4)
Concern that my vet will not be open/available if I need them for non-emergencies

 

 683 (17.1) 1103 (27.6) 1434 (35.9) 672 (16.8) 104 (2.6)
Concern about having to leave the house if my dog gets injured or sick 1078 (27.0) 1140 (28.5) 1076 (26.9) 552 (13.8) 150 (3.8)

How these findings can assist veterinarians

Capitalizing on these results, veterinarians have the opportunity to better address their clients’ concerns. Helping your clients understand that your veterinary hospital will work with them to meet their pets’ needs, and proactively reach out to your clients and explain your new (and changing) protocols. Perhaps you might want to offer guidance to your clients in determining an appropriate designated caretaker. And most importantly, as we all transition into this new reality, reassure your clients that your medical team will continue to be there for them in their times of need. To learn more, you can access the full report at https://fidofortcollins.org/

Does the coronavirus mean your patients need masks?

Dr. Sam Kovac, BVSc (Merit), Chartered member of the Australian Veterinary Assoc. Member, Royal College of Vet Surgeons, UK, MSGFC.
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Does the coronavirus mean your patients need masks?

Is COVID-19 transmittable between humans and animals? Are masks necessary? We explore precautions  your clinic should be taking

We’ve heard multiple reports that companion animals cannot carry or transmit the novel coronavirus COVID-19. This has now been refuted with domestic cats, dogs, and big cats having contracted COVID-19.

A 17-year old Pomeranian belonging to a coronavirus patient in Hong Kong tested “weak positive” for COVID-19, and veterinarians assumed that the dog had picked up the virus from its caretaker.

The recent case of a tiger at the Bronx Zoo testing positive for COVID-19 leads to even more questions about whether previous assumptions about whether pets can carry and transmit this virus are true. Even before two dogs in Hong Kong tested positive for COVID-19, some pet parents were already opting to err on the side of caution, having their dogs wear masks during walks through heavily populated city centers.

CDC and AVMA representatives weigh in

After news of the first COVID-19 positive tiger broke, we learned that three lions and three more tigers at the Bronx Zoo tested positive after developing symptoms. The big cats were under the care of an asymptomatic keeper, again suggesting that humans may transmit the disease to animals even without showing any signs of COVID-19.

MarketWatch asked American Veterinary Medical Association President Dr. John Howe whether it’s possible for humans to get COVID-19 from pets. Howe replied that “the answer at this point is no. At this time, there is no evidence that companion animals, including pets, can spread COVID-19 to people or that they might be a source of infection in the United States.” But not having diagnosed a case yet doesn’t mean that animals can’t spread COVID-19 to humans. In the future there may be cases of this occurring.

The reason for this is COVID-19 requires special ‘cell surface proteins’ which act like doors to enter a body and cause infection. Without these ‘doors’, viruses can’t attach to human or animal cells and this explains why some species catch certain viruses but can’t spread it to other species. ‘ACE2’ is the ‘door’ COVID-19 uses to infect humans. The concerning part is that this specific cell surface protein called ‘ACE-2’ is present in both humans and our canine friends, making COVID-19 theoretically possible to be passed from humans to dogs and potentially vice-versa.

On its Coronavirus and Animals page, The CDC repeats Dr. Howe’s statement and maintains that “CDC has not received any reports of pets becoming sick with COVID-19 in the United States. Furthermore, they recommend that people who have COVID-19 should restrict contact with pets and other animals, at least until more information is known.

Neither CDC nor AVMA recommend masks for pets. Instead, they recommend that those who are sick with COVID-19, or who suspect that they may have the virus but haven’t tested positive should:

  • Limit contact with their pets and other animals
  • Have another member of the household care for pets
  • Avoid contact such as petting, snuggling, being kissed or licked
  • Avoid sharing food or bedding with their pets. If you have a young pet who usually sleeps in your bed or likes to wander, consider a spacious puppy pen

In the event that someone who has or suspects they have COVID-19 must take care of their own pet, CDC recommends handwashing before and after contact with pets. Furthermore, they recommend that the patient wear a cloth face covering.

Given that there is evidence that all the animals who have caught COVID-19 did so from the virus crossing from human to animal, it is very reasonable to suggest that all caregivers and those who interact with animals wear masks to prevent droplet transmission. The troubling part is that pet parents and animal care workers can transmit the virus to the animals they are in close contact with, without even knowing they are infected with the viruses themselves.

What about cats? 

There have been cases of cats getting COVID-19 in Hong Kong and Belgium to name a few countries. So the question must be asked: if a cat is in contact with a COVID-19 positive human, what steps should caregivers take?

  • Triage the case – if the case is not critical or an emergency, please reschedule until after the caretaker has cleared quarantine
  • Wear PPE when examining the cat – a mask, eye protection, gloves and a disposable or washable gown
  • Minimal handling of the cat
  • Practice good hand and environmental hygiene
  • If you need to hospitalise a cat who has had exposure to a COVID-19 positive human patient, it should be isolated from other animals and staff should wear PPE when cleaning cages or handling the cat
  • Only perform essential procedures to any cat in contact with a COVID-19 positive human. A P2 mask is required for all in-contact staff if doing a procedure where aerosol may be generated. This includes intubation. Ensure you do a fit check on your mask

Protect your practice 

Even though animal patients don’t need to wear masks, there are ways that you can protect your practice during the COVID-19 pandemic. Consider:

  • Implementing telemedicine
  • Transferring patients to your clinic in the parking lot
  • Postponing elective procedures
  • Wearing a mask and practicing safe social distancing when meeting with pet parents
  • Accepting online payments when possible
  • When clients enter the office, ask them to wear a cloth mask, practice social distancing, and sanitize common areas afterward. Also make it mandatory that they hand sanitize before entering the premises
  • Temperature test your staff twice a day (at shift sign-on and around 2pm). Any staff with temperatures 99.5F or above should be sent home.

There are many unknowns and the situation continues to evolve. For in-depth information, read AVMA’s COVID-19 FAQs for Veterinarians.

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